Life after traumatic brain injury

Editor’s note: In “Brain Sprain” (issue #153) we examined the after-effects of Traumatic Brain Injuries (TBI) and Post-Concussive Syndrome (PCS) from a medical standpoint. That’s only half the story—Jason Carter shares his first-hand account of living with the effects of severe head trauma.

As I started regaining consciousness could hear the EMTs behind me asking the routine questions to gauge the severity of my injury. Instead of responding I ignored them. I could hear and feel one of them to the left behind me, his leg against the back of my ribcage supporting me while I sat with my arms resting on my knees. I could hear and feel a female EMT behind me to my right bandaging my head. Instead of responding I looked around and absorbed what was in front of me. It was dark and a crowd had gathered around, pointing, gawking and talking amongst themselves. The sun had set for the day and the crowd was illuminated by the flashing red, white and blue lights from the fire truck, ambulance and police vehicles that lined the street. In front of me, about 15 feet away, I became fixated. I could see my Cannondale 29er still lying in the street, surrounded by a pool of blood. I thought to myself “Damn, I was out for a while” and knew I was lucky to be alive.

“Sir, what’s your name?”

Again, I ignored the paramedics and kept looking around. I wasn’t trying to be an asshole, and given the situation, I knew that they were asking the basic questions to gauge how severe of a head injury I had. I looked around a few moments more, my eyelids operating like the shutter of a camera taking mental images of my surroundings. “I’m alive,” I thought, “so hard part’s over.”

Again, I heard the questions. “Sir, what’s your name?”

Finally, I relented, “Jason.”

“Jason, how old are you?”

“Too old for this shit.” People in the crowd laughed. The EMTs didn’t. Again they asked my age, and this time I gave a more sincere answer.

“Seriously , I’m too old for this shit.”

Anyone that knew me knew that was my typical style. The EMTs, however, wanted more serious answers. I obliged by telling them my name, where I lived, what year it was, who the president was, and the like. We joked that it was a good thing I shave my head since it will save the medics some work. I was then strapped to a back board, loaded into the ambulance, and hauled off to the ER.

While sitting in the ER, waiting to be taken for a CT scan, I thought about how I managed to find myself strapped to that damned uncomfortable back board, the corner of it digging into the back of my head. I was covered in blood, my shirt was torn nearly half off, my head was bandaged, and the skin (as well as some meaty tissue) along the top of my right shoulder, from my neck to my shoulder joint, was gone. I no doubt looked like an extra from a zombie flick.

How it Happened

After putting in a couple hundred miles on the bike I took it in for a free service. Basic stuff like cable stretch and a once-over. I picked the bike up, took it home, and decided to go out for a few trips down the street to double-check shifting before taking the bike out on the trail. I opted to ride in tennis shoes instead of my cycling shoes, and since I was “just” riding down the street I choose to ride without a helmet—after all, it wasn’t worth the hassle to just make sure everything was in working order.

While I riding, I passed by my neighbor, Walter’s house. His teenage son was getting on his bike and asked his dad to come out and race him. Walter told his son that if he wanted to race that I would probably race him since I was already on my bike. I decided it would be fun, so I agreed.

We lined up, Walter’s son counted to three, and we were off. Both of us were out of the saddle and smashing the pedals as we clicked through the gears. My chain bound up as I shifted to the big ring. I was out of the saddle and my right foot slipped off the pedal. I knew I was going down and tried to “tuck and roll.” I learned in the military that when you’re falling at a decent speed and try to catch yourself three things will happen: you will still fall, you will likely tear up the palms of your hands, and you just might dislocate your shoulder. In the military, I did all three—and then I used my good arm to pop my shoulder back into its socket.

That single incident left a lasting impression. An impression so strong I instantly fought my body’s natural reflex to stick my hands out the second I knew I was going down. As my right foot slipped off and struck the ground, I felt my ankle roll in. I was headed to the ground. I tucked my right arm in, let go of the bike, and prepared to take the roll. It was going well, too. I went down onto my right side and could feel the asphalt taking skin and flesh off my right elbow and forearm…and then I opened my eyes and found myself sitting on the curb, taking in the scene while the EMTs attended to me.

Then the cell phone rang. My neighbor, Russell, was in the room with me and he handed me the phone. It was my wife. She was due to come home for two weeks of R&R from Afghanistan, and she was calling from Kuwait before she boarded a plane on her journey home.

We said our hellos and she asked what I had been up to that day. “Not much,” I said. “I picked my bike up from the shop and Russell and I worked on tile in the bathroom.”

“What are you doing now?”

I looked up at the television, saw that the news was on and said, “Right now? Oh, I’m just laying here watching the news.” It was the truth, the news was on. I figured there was no point in telling her, because if she knew I was in the ER, she would be worried for the rest of her trip home. The doctor stuck his head in the door “We’re ready.” I told her I had to go, that Russell needed my help with the tile, and I’d see her at the airport. I hung up and was wheeled away for the CT scan.

With the CT scan complete and the initial assessments over, I was wheeled back to the room in the ER and finally taken off that back board. A woman then came in to remove the bandages from my head, clean it, and put staples in. The moment she started flushing the wound I went into an immediate sweat. I’ve had some nasty, bloody wounds before and all of them had a certain amount of pain associated with them, but this was a whole new level of pain. The pain I felt while just having the wound on my head flushed was the first pain I’d ever experienced that I would define as excruciating. It was the first time I experienced a pain so intense that it made me sick to my stomach. I was then told that she was going to put the staples in, and that since I had a head wound, they could not give me a local to numb me.

Staples. No local to numb the pain. In my head, I thought about the best course of action to take. I knew that there was no way in hell I was going to be able to keep my head still while this nurse Frankensteined my scalp. I asked her to place her finger at each location where the staples would go. She placed her finger at the first spot. “Now, press with your finger.” Excruciating.

I stood up, asked her to lay the bed flat and drop the rails. I took the monitoring equipment off, laid on my stomach, turned my head so the nurse could access my wound, grasped the rails at one end of the bed, and then hooked the toes of my feet in the stirrups at the other end. “Do what you’ve gotta do.” This must have made her nervous because, as I laid there, left side of my face against the bed and her standing in front of my face, I could see her hands shaking. “What are you nervous for? It’s not like you’re getting staples in your head or anything.” I guess my comment had the desired effect. She laughed and seemed to calm down. One by one the staples went in. Ka-chunk. Ka-chunk. Ka-chunk. “Oh, I’m sorry. I missed with that one. I’m going to have to take it out.” She removed the stray and continued…

Once I was patched up, I spoke with the doctor once more. He told me that I was lucky to be alive. The injury I sustained would have killed a lot of people. I was told that if I had prolonged headaches or dizziness I should come back. I was given a prescription for Percocet and sent home. I didn’t bother with picking up the prescription because, in my mind, the hard part was over. I woke up, I’m breathing, and the pain is mostly gone. Once I scab up and my skin heals I’ll be back to normal.

I was wrong.

After Effects

That accident happened on June 8, 2008. The next day I went to the kitchen to get a sandwich and take it to the living room to eat. I got to the living room, sat down, and realized I didn’t have the sandwich with me. I got up, went to the kitchen to get the sandwich, returned to the living room, and sat down, only to realize that, once again, I didn’t have the sandwich with me. I had three unsuccessful attempts at getting to the kitchen, getting that sandwich and making it back to the living room. The fourth time I forced myself to stay focused on what I was doing the entire time I was doing it. “Getting a sandwich, getting a sandwich, getting a sandwich…” It’s not like I had to go make it, it was on a plate. I just had to get it, pick it up and carry it out of the kitchen. I failed the first three times. It was an odd feeling. I knew what I needed to do, I just couldn’t do it. Each time I failed and realized I had failed, I was aware of it, but still repeated my failure.

Later that day I ventured outside and talked to the neighbors. Walter handed me my bike and my cycling computer that had broken off in the crash. I pulled up the max speed from the previous day, it read 27 MPH. Walter and I talked for a while and he asked me what I remembered. I told him everything I knew—I was going down, tucked so I could roll, and then woke up on the curb, EMTs were bandaging me, and everyone was gathered around.

“No, that’s not how it happened,” Walter explained, “you wiped out and laid there in the street while my son came to get us. I ran down there and you didn’t respond but you were breathing. I tried waking you up and when you woke up you started walking to your house. I asked where you were going and you said you were going to take a shower and get cleaned up. I tried to tell you to sit down because you were hurt and you got upset; you were ready to fight.”

“Really?”

“Yeah, man. It scared the hell out of me. You standing there with your head hanging open, clothes torn off, bleeding all over, and you were ready to fight.” I apologized and told him about the sandwich issues I’d had earlier. We talked for a while longer, until the sun heated the staples in my scalp to a point that I couldn’t stand it anymore.

That was in 2008. I was told that it’s common for memory to be clouded for a while after suffering an injury like I did, but my effects have lasted much longer, and I’m not sure they will ever disappear.

I can be in the garage working on a project, have a tool in my hand, put it down, then reach for it again, only to find that it’s not there. Situations like that always result in a frustrated search for the tool. I’ve found them in areas of the house that make no sense. “I have no idea how the adjustable wrench found its way to the kitchen counter. Did I go to the kitchen? Was I getting something to drink? I don’t have a drink in my hand. What was I doing in the kitchen?”

Situations like that are common for me, and honestly, I didn’t figure them to be that big of a deal. So what if I forget where I put a tool? Since 2008, I’ve learned how to deal with what seems to be the lasting effects of my brain injury. I knew my short term memory had suffered but, thankfully, it hadn’t had an effect on my family. Situations where I’m working and misplace an item or walk into a room and not know why I’m there just make me look foolish to those around me. No big deal. Joke is on me, I can deal with that.

The truth is, I’m aware of my memory problem, and have been since the accident. I use my cell phone to set reminders of important things I can’t afford to forget, just in case. To me, I knew I had a problem with short-term memory, but I figured I had managed to work with and around it to keep things under control. My toolbox stays well-organized. Everything has a place and each tool is put back in place after it is used. I’ve become what some would call OCD about keeping things organized so I can find them later. Since I forced myself to stay more organized, I found I had less forgetful moments in the garage. Success! And then it happened…

About three months ago the kids and I were in the truck and had just pulled into the cul-de-sac. My neighbor was outside and threw his hand up. I stopped, we exchanged hellos, and he asked what we had been up to. I was blank—I couldn’t answer. I looked at my daughter, hoping she would say something. She didn’t. I stumbled, I faltered, I tripped over my own tongue trying to say something, anything, about what we had done that day. I couldn’t name a single thing we had done or where we had been. Finally, I saw a cup that was in the console from a restaurant and told him we had gone there. We finished our discussion and I pulled into the driveway, feeling sick to my stomach. I spent an entire day with my kids and had no recollection of any of it. None. I couldn’t remember a single thing we did that day. I still can’t remember what we did that day. My daughter told me that we went to the mall, got some food, and swung by the bike shop, but I’m oblivious to any of it.

Untreatable

I talked to a specialist, who told me there’s little that can be done to improve my situation. For the most part, what I’ve been doing to stay on top of things keeps me straight. I still forget to do certain things. In July of 2010, I bought my wife an anniversary card to mail to her in Afghanistan. Our anniversary is in August, so I wanted to make sure it got there in time. When she returned for R&R in October, she opened the console of the truck and found the card. She questioned me about it. I just gave her a sheepish grin, “It’s the thought that counts, right?”

In an attempt to keep my mind busy and hopefully sharpen my short-term memory, I’ve enrolled in college to finish my electrical engineering degree. I’ve found this to be a challenge, but I’m pushing on to earn my degree and hopefully jump-start my finicky short-term memory. During the day I function fine, but find myself unable to recall previous portions of the day. While this makes college a challenge, I persevere.

I don’t feel as intelligent as I was prior to the accident. Oftentimes I can’t get my thoughts out of my head—if I can remember what it is I wanted to say to begin with. While I’m not sure that I’ll ever fully recover from my injury, I’m positive that my situation could have been prevented if I had simply worn a helmet. Even though it was intended to be a brief ride up and down the street to check operation of my bike, it turned into so much more.

Lesson Learned

I occasionally put the scars on my head and shoulder to good use. Since my accident we’ve moved and have new neighbors and new kids around, and like most kids, they love riding bikes. My neighbors’ kids used to put up a fight with their parents about wearing their helmets. I figured it was a good time to show them what could happen if they didn’t. I pulled them aside, showed them my scars, and told them about the staples going into my head. For added effect, I brought them into the garage, picked up the staple gun and demonstrated with a piece of wood. “Imagine a nurse putting these in your head.” Since that day, I have yet to see those kids riding without a helmet.

If given a choice between sanding your scalp on the asphalt or putting on a helmet, anyone with common sense is going to choose the helmet. That decision is made every time we get ready to ride, even when we think we won’t need it.